Another day, another clear example of the "free" market ossifying into monopoly absent effective government regulation, while common people suffer.
I yearn for the day that humanity reaches Star Trek ideals, and looks back on people like the Milan CEO the way we regard magnanimous tyrants and bloodthirsty war criminals.
The same government that protects patents and prevents you from buying from overseas suppliers. I buy all my prescription meds direct from India where I pay them with bitcoin. It's the exact same stuff and way cheaper.
Are you sure it's the exact same? There have been studies looking at quality/purity of medications manufactured in different countries, and they don't all have high standards of purity.
This market is not free at all. There is a reason that Mylan has been the only company offering this product. The FDA has been slow to approve additional devices in this market. Mylan also created this market by lobbying congress to give money to schools to stock them with EpiPen's. When Mylan was testifying before congress the gentleman from the FDA refused to give any insight as to when additional manufactures might be given permission to manufacture competitors or provide any insight into the delay.
This is the beauty and the beast of "Free markets". In most cases, you get what free markets boast about - more competition, reduced pricing, better service.
If you were to look at the statistics, these would either be edge cases or outliers when considering the overwhelming evidence that in most cases, free markets are far better than having burdensome government regulations.
It's funny to hear people complain about how bad the free market system is in this case, but are also crying about employment immigration issues and how we can't get MORE H1-B's visa's, and why SV companies can't bring in more highly skilled candidates from other countries.
It cuts both ways. There is a median in there. Heavily regulated or totally free markets never work, we need to find a balance.
EpiPen prices occur in a heavily regulated market. Mylan has a patent on the mechanism they sell (no generics from other companies) and there are all sorts of regulations surrounding the production of any drug offered for sale in the US.
The current state of EpiPen is a direct result of free will of the original inventor and the company he worked for when he developed it. The company which is currently an "evil monopolist" acquired the rights to it as result of free-market, mutually beneficial transactions. Yes, they offer the tech for a lot of money - but you are _free_ not to purchase it and use older medicine instead.
The problem with your type of logic is illustrated best not by the complicated reality, but (as usual with philosophical problems) a corner case. Imagine that I invent a fantastic new medicine - and being an evil genius, leave it in my lab, never announcing it to the world, knowing perfectly well that millions of people around the world could be saved if I did.
In your logic, this absence of action makes me evil - although these poor sufferers would suffer just the same if I didn't invent this new medicine to begin with. The same is true for EpiPen: it's their inaction you condemn, not action.
The medical industry is not making the world a worse place through it's actions; it just isn't doing it a better place to an extent that you would want them to.
Mylan bought it after someone came up with a minor improvement to the needle cap and it could be marketed under a patent.
The ridiculous price has little to do with the original inventor.
A not stupid regulatory system would evaluate the value of the improvement to the market (likely hugely negative in this case). The idea wouldn't be to deny the company the right to the patent, it would be to deny regulatory approval for the patented version of the device.
(the argument being that decreased access to the patented device costs more than the benefit provided by the minor safety improvements it offers).
A simple implementation would force them to market the new pen under a different name.
They would of course argue that this confuses the marketplace. But they are sitting there exploiting the confused marketplace, so not much of an argument to be made along those lines.
There used to be a time when the monopolist would not raise price to whatever they could ge away with. Daraprim was very affordable for 50 years until Shkreli bought out the manufacturer, the same with Epipens, until Mylan bought the product from Merck KGA. One could easily find more examples if one went looking.
Something changed in ths mid-90s. Neoliberalism became salonfähig, or something.
In your example I wouldn't go so far as to say you would be evil, perhaps just morally bankrupt or at the very least lacking in empathy.
You have someone like Jonas Salk who basically fit your example perfectly, except he decided to share his invention with the world instead of hiding it away as per your example.
You're free to not share your cure with the world, no one could force you, but I would question the motivations of someone who chose not to.
tl;dr Sanofi filed a lawsuit against Mylan alleges antitrust behavior. Essentially the article says that Mylan jacked up prices but offered steep rebates to "third party payors" on condition that they do not reimburse Auvi-Q (made by Sanofi) effectively shutting them out of the market.
To me though the kicker was at the very end -- "The list price of the newly released Auvi-Q is set at $4,500." That is for the device now being sold by another company (Kaleo). I just don't understand what is going on here. EpiPen is priced at what $600? CVS sells a generic for about $100 (Adrenaclick).
One factor is that "Adrenaclick" is not a generic EpiPen. It is a different branded epinephrine autoinjector, with generic versions available. The FDA regulates epinephrine autoinjectors so that a prescription for EpiPen must be filled with an injector that has the same operating instructions as EpiPen. Adrenaclick and generics do not have the same operating instructions as EpiPen.
It's not a completely ridiculous regulatory decision, but it certainly factors into people not using the alternatives.
This 'Auvi-Q' thing... I don't get it. It's just a rectangular EpiPen.
Oh wait, it talks to you. Why do you need an EpiPen to talk to you? You literally just take the cap off, whack it to your (or their) thigh, and count to 5.
You literally just take the cap off, whack it to your (or their) thigh, and count to 5.
In an emergency situation it's occasionally other parties, with no experience or knowledge of these devices, who administer. The design decision was likely made for observed reasons.
1. Auvi-Q is about 2"x3"x.5", and fits unobtrusively in my pocket. EpiPen is about 8" long, making it awkward to keep with you. For that reason alone I carry Auvi-Q.
2. Except you missed a step - you have to take off the cap AND the safety. I don't need an EpiPen to tell me how to use it, but if my son is anaphylaxing, I want a panicking 15 year old babysitter to have a device that is as fool proof as possible.
> You literally just take the cap off, whack it to your (or their) thigh, and count to 5.
In at least one study[1], admittedly funded by Sanofi, ~1/3 of people stuck the wrong end into their thing and ~1/2 didn't keep it in long enough. Just to emphasize on the second item, you said "count to 5" when the EpiPen instructions say 10 seconds. Only 35% of people completed all the steps correctly.
So what are the chances that a US federal court is going to rule against a US company with a near 100% marketshare versus a French company that no longer sells the product?
I always advocate that medical service providers and pharma should be required to charge the same price to all customers for a given service. Different providers/doctors would be free to charge different prices of course. Discounts, rebates, and any other special pricing should not be allowed. The only possible exception would be a charging LESS for someone (an individual) who is not insured or has some other financial hardship.
A more elegant solution in my mind, barring price fixing, would just be price transparency. Let people see the costs and use their own judgement to pick what they value more.
- Price transparency for common treatment/diagnosis.
- They must charge insured and uninsured the same rate, no more 70% discounts for the insured.
This would, if nothing else, get the insurance company and patient on the same team (since they're both fighting for lower prices across the board, rather than just higher insurance discounts on bonkers pricing).
Why should the insured get a discount at all? Or do you mean their insurance would cover 70 percent of the cost? It is a common practice to charge less to insurance companies than patients. I had a friend with a high deductible who used to have everything billed through his insurance company - because it was cheaper that way even though he paid the whole thing while below his deductible. This amounts to screwing the uninsured people who need a price break the most. It's seriously unjust.
That's exactly what I'm talking about. Transparency just adds the idea of publishing the price up front.
I tried to clarify - different doctors are free to charge different rates for a given service (say 15K for an appendectomy), to make them charge the same is price fixing and should not be allowed. What I advocate is that Alice, Bob, and Charlie all get charged the same price by Dr. Sam regardless of insurance coverage or any of the other deals that take place today. Dr Alfred is free to charge a completely different price than Dr Sam.
Sorry, but I'm not sure I understand. I was under the impression that different doctors could already charge different rates for the same procedures. Insurance companies could just refuse to reimburse after a certain percentage, though.
The problem is that a given provider (doctor or hospital) charges different rate to patients for the same service (procedure). Now lets not confuse what the patient pays with what the provider receives because insurance can be involved. the thing is the insurance companies "negotiate" lower rates in addition to paying their portion of the bill.
Say two people get their appendix out and the hospital bill is about 15K. One person is uninsured, so they get a bill for the full amount. The other is insured, so their insurance company gets a bill for 15K. The insurance company has an existing agreement with the hospital and says "We're only going to pay 12K" and that's what the hospital gets. Then they pass on the 30 percent of 12K to the patient and get that. This is seen as a bonus the insurance companies provide - negotiating better prices - 12K vs 15K. But what's really happening is the hospital is going to try to get 3K more from the uninsured guy.
My argument (how I think it should be) is that the hospital has to demand the same payment from everyone for that procedure - you will be responsible for whatever portion your insurance company doesn't pay, which is full price for the uninsured. Now the other hospital across town is free to offer the same procedure for 13K or 8K or 25K - whatever they think they can get, but they have to charge that price to all patients. This promotes competition between providers AND insurance companies and it will result in lower prices for both.
So how granular can the price be? Say you need stents for your coronary artery disease. Do you price at the number of stents? The number of catheters used? Just a flat rate for a procedure, regardless of the complexity?
So Mylan is more evil than Satan's pet vulture for hiking the price of EpiPen to $600, and the good guys just released a new version of their device for $4500? Or am I reading TFA wrong?
Yeah I don't understand the $4500 price. Is that per dose? Or is it some sort of reusable device? Either way it is hard to see that being a viable competitor.
I think the argument here is that they were forced to sell the competing product to a new vendor (due to stifled competition) whom are now pricing at $4500, which they weren't.
It's for 2 pens I believe, last time I checked on their website. The company is trying to get insurance to cover the costs, so cost for you wouldn't technically change, but it just increases healthcare costs all around for no reason other than profit.
I think the argument here is that they were forced to sell the competing product to a new vendor (due to stifled competition) whom are now pricing at $4500, which they weren't.
You are reading this wrong. Sanofi, the company that filed the lawsuit, had pricing in line with EpiPen:
"In 2013, Sanofi began selling Auvi-Q, which works to quell life-threatening allergic reactions, just as EpiPen does. Sanofi priced Auvi-Q on equal footing with EpiPen. And, initially, Sanofi claims it showed promise of gaining market share and providing real competition to EpiPen, which at the time had more than 99 percent of the market, according to Mylan. But that all changed when Mylan began using dirty tactics, Sanofi alleges."
Looks like Sanofi sold the product to another company - the $4500 number is a price from the company Kaléo.
"In 2015, Sanofi pulled Auvi-Q following quality control issues. The device has since been put back on the market by another pharmaceutical company, Kaléo. The list price of the newly released Auvi-Q is set at $4,500."
Sorry, still not seeing the good-and-evil story here. Look at the graph here: https://www.forbes.com/sites/matthewherper/2016/10/26/epipen... (possibly what you meant by prices in line with EpiPen) - Sanofi was matching the price increases of EpiPen dollar for dollar for years, and was always a little bit more expensive. Then it went away from the market for some kind of quality control problem, and returned as a $4500 device manufactured by another company (but with a weird pricing scheme which supposedly lets anyone who needs it to buy it for low out-of-pocket costs). Honestly that graph looks like both companies conspiring to corner the market together, if anything; but who knows with the insane prices and regulations of healthcare.
I am not saying either one is good or evil here, just commenting that the $4500 device is not super relevant to the actual Sanofi lawsuit.
Obviously Sanofi should have been able to massively undercut the Mylan price if there truly was xxx% profit margin built in, so it is not really apparent why they didn't do that.
Well, it's like Bernie Madoff said - "there is no innocent explanation". They hiked the price from $130 to $500 while matching Mylan every step of the way; they fixed prices. Their lawyers may be good enough so that they never get charged with it, but it's clear that they did it, and they and Mylan are both exactly the same and just as guilty. And now this lawsuit seeks to cast them as some kind of underdog and victim.
My point about "good guys" was because of the whole tone of the article. A romantic story of two brothers, one of whom became a doctor, and another an engineer, so that they could invent their dream automatic injector. Except that autoinjectors are a 1950s technology, used by most militaries to deliver antidotes to chemical weapons - here's a film from 1963 which demonstrates a device that I have a hard time telling from an EpiPen: https://www.youtube.com/watch?v=oeyW8aoP8mE.
So what the hell was there to even invent, why are these devices covered by any patents at all, why is the FDA allowing just two companies to dominate the market (I am sure plenty of people would like to charge $100 for devices which cost a few dollars to manufacture), and why doesn't a lockstep price hike from $130 to $500 attract the attention of antitrust prosecutors? Because healthcare in the USA is an insane fever swamp...
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[ 8.7 ms ] story [ 1382 ms ] threadI yearn for the day that humanity reaches Star Trek ideals, and looks back on people like the Milan CEO the way we regard magnanimous tyrants and bloodthirsty war criminals.
3 month supply costs less than one months co-pay.
http://www.npr.org/sections/health-shots/2016/09/01/49223579...
https://www.fda.gov/NewsEvents/Testimony/ucm521839.htm
If you were to look at the statistics, these would either be edge cases or outliers when considering the overwhelming evidence that in most cases, free markets are far better than having burdensome government regulations.
It's funny to hear people complain about how bad the free market system is in this case, but are also crying about employment immigration issues and how we can't get MORE H1-B's visa's, and why SV companies can't bring in more highly skilled candidates from other countries.
It cuts both ways. There is a median in there. Heavily regulated or totally free markets never work, we need to find a balance.
The problem with your type of logic is illustrated best not by the complicated reality, but (as usual with philosophical problems) a corner case. Imagine that I invent a fantastic new medicine - and being an evil genius, leave it in my lab, never announcing it to the world, knowing perfectly well that millions of people around the world could be saved if I did.
In your logic, this absence of action makes me evil - although these poor sufferers would suffer just the same if I didn't invent this new medicine to begin with. The same is true for EpiPen: it's their inaction you condemn, not action.
The medical industry is not making the world a worse place through it's actions; it just isn't doing it a better place to an extent that you would want them to.
The ridiculous price has little to do with the original inventor.
A not stupid regulatory system would evaluate the value of the improvement to the market (likely hugely negative in this case). The idea wouldn't be to deny the company the right to the patent, it would be to deny regulatory approval for the patented version of the device.
(the argument being that decreased access to the patented device costs more than the benefit provided by the minor safety improvements it offers).
I'd take my systems stupid and simple, please.
They would of course argue that this confuses the marketplace. But they are sitting there exploiting the confused marketplace, so not much of an argument to be made along those lines.
Something changed in ths mid-90s. Neoliberalism became salonfähig, or something.
You have someone like Jonas Salk who basically fit your example perfectly, except he decided to share his invention with the world instead of hiding it away as per your example.
You're free to not share your cure with the world, no one could force you, but I would question the motivations of someone who chose not to.
Your claim is factually incorrect. The issue here is specific, purposeful, anticompetitive behavior.
To me though the kicker was at the very end -- "The list price of the newly released Auvi-Q is set at $4,500." That is for the device now being sold by another company (Kaleo). I just don't understand what is going on here. EpiPen is priced at what $600? CVS sells a generic for about $100 (Adrenaclick).
It's not a completely ridiculous regulatory decision, but it certainly factors into people not using the alternatives.
Oh wait, it talks to you. Why do you need an EpiPen to talk to you? You literally just take the cap off, whack it to your (or their) thigh, and count to 5.
In an emergency situation it's occasionally other parties, with no experience or knowledge of these devices, who administer. The design decision was likely made for observed reasons.
2. Except you missed a step - you have to take off the cap AND the safety. I don't need an EpiPen to tell me how to use it, but if my son is anaphylaxing, I want a panicking 15 year old babysitter to have a device that is as fool proof as possible.
In at least one study[1], admittedly funded by Sanofi, ~1/3 of people stuck the wrong end into their thing and ~1/2 didn't keep it in long enough. Just to emphasize on the second item, you said "count to 5" when the EpiPen instructions say 10 seconds. Only 35% of people completed all the steps correctly.
[1] http://www.jaci-inpractice.org/article/S2213-2198(13)00125-6...
Ow...
- Price transparency for common treatment/diagnosis.
- They must charge insured and uninsured the same rate, no more 70% discounts for the insured.
This would, if nothing else, get the insurance company and patient on the same team (since they're both fighting for lower prices across the board, rather than just higher insurance discounts on bonkers pricing).
I tried to clarify - different doctors are free to charge different rates for a given service (say 15K for an appendectomy), to make them charge the same is price fixing and should not be allowed. What I advocate is that Alice, Bob, and Charlie all get charged the same price by Dr. Sam regardless of insurance coverage or any of the other deals that take place today. Dr Alfred is free to charge a completely different price than Dr Sam.
Say two people get their appendix out and the hospital bill is about 15K. One person is uninsured, so they get a bill for the full amount. The other is insured, so their insurance company gets a bill for 15K. The insurance company has an existing agreement with the hospital and says "We're only going to pay 12K" and that's what the hospital gets. Then they pass on the 30 percent of 12K to the patient and get that. This is seen as a bonus the insurance companies provide - negotiating better prices - 12K vs 15K. But what's really happening is the hospital is going to try to get 3K more from the uninsured guy.
My argument (how I think it should be) is that the hospital has to demand the same payment from everyone for that procedure - you will be responsible for whatever portion your insurance company doesn't pay, which is full price for the uninsured. Now the other hospital across town is free to offer the same procedure for 13K or 8K or 25K - whatever they think they can get, but they have to charge that price to all patients. This promotes competition between providers AND insurance companies and it will result in lower prices for both.
"In 2013, Sanofi began selling Auvi-Q, which works to quell life-threatening allergic reactions, just as EpiPen does. Sanofi priced Auvi-Q on equal footing with EpiPen. And, initially, Sanofi claims it showed promise of gaining market share and providing real competition to EpiPen, which at the time had more than 99 percent of the market, according to Mylan. But that all changed when Mylan began using dirty tactics, Sanofi alleges."
Looks like Sanofi sold the product to another company - the $4500 number is a price from the company Kaléo.
"In 2015, Sanofi pulled Auvi-Q following quality control issues. The device has since been put back on the market by another pharmaceutical company, Kaléo. The list price of the newly released Auvi-Q is set at $4,500."
Obviously Sanofi should have been able to massively undercut the Mylan price if there truly was xxx% profit margin built in, so it is not really apparent why they didn't do that.
My point about "good guys" was because of the whole tone of the article. A romantic story of two brothers, one of whom became a doctor, and another an engineer, so that they could invent their dream automatic injector. Except that autoinjectors are a 1950s technology, used by most militaries to deliver antidotes to chemical weapons - here's a film from 1963 which demonstrates a device that I have a hard time telling from an EpiPen: https://www.youtube.com/watch?v=oeyW8aoP8mE.
So what the hell was there to even invent, why are these devices covered by any patents at all, why is the FDA allowing just two companies to dominate the market (I am sure plenty of people would like to charge $100 for devices which cost a few dollars to manufacture), and why doesn't a lockstep price hike from $130 to $500 attract the attention of antitrust prosecutors? Because healthcare in the USA is an insane fever swamp...
[1] https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen